Bochdalek hernia with intrathoracic kidney as one of its contents - Incidentally identified by 99mTc-DTPA renogram

Document Type : Case Report


Department of Nuclear Medicine & PET/CT, Amrita Institute of Medical Sciences, Cochin, Kerala, India


Congenital diaphragmatic hernia (CDH) is a rare anomaly with a reported incidence of 1 in 16,000 populations. It may be associated with herniation of stomach, intestinal loops, spleen, and kidney through a chest wall defect. We report a case of a 1 year old male child who presented with recurrent fever, occasional chills and rigor of 4 months duration. Left kidney was non visualised on ultrasound examination. Patient was referred for a 99mTc DTPA (Diethylenetriamine  penta-acetic acid) renogram to look for the presence of an ectopic left kidney. An intrathoracic left kidney was identified that was normally functioning and PUJ (pelviureteric junction) non obstructed. A routine chest X-ray was performed to look for respiratory tract infection that showed bowel loops in left posterior thorax, raising a suspicion for CDH. The patient underwent thoracoscopic repair of CDH and the hernial contents were found to be left kidney, intestinal loops and spleen. Intrathoracic kidney is relatively rare and constitutes 5% of all ectopic kidneys and is invariably PUJ non obstructed.


Main Subjects

Angulo JC, Lopez JI, Vilanova JR, Flores N. Intrathoracic kidney and vertebral fusion: a model of combined misdevelopment. J Urol. 1992 May;147(5):1351-3.
Arafah M, Boqari DT, Alsaad KO. Left-sided congenital diaphragmatic hernia with multiple congenital cardiac anomalies, hernia sac, and microscopic hepatic heterotopia: a case report. Patholog Res Int. 2011 Mar 15;967107.
Sweed Y, Puri P. Congenital diaphragmatic hernia: influence of associated malformations on survival. Arch Dis Child. 1993 Jul;69(1 Spec No):68-70.
Ohta H, Kohno K, Kojima N, Ihara N, Ishigaki T, Todo G, Komibuchi T. A case of diaphragm hernia containing accessory spleen and great omentum detected by Tc-99m phytate scintigraphy. Ann Nucl Med. 1999 Oct;13(5):347-9.
Shah AD, Ajay S, Adalia M, Rathi A. Bochdalek hernia with intrathoracic kidney. Lung India. 2012 Oct;29(4):373-5.
Bláhová K., Šnajdauf J., Tůma S., Černý M., Jančíková B., Janda J. Intrathoracic kidney renal ectopy. Čes-slov Pediat 2001; (10): 590-3.
Kluth D, Keijzer R, Hertl M, Tibboel D. Embryology of congenital diaphragmatic hernia. Semin Pediatr Surg. 1996 Nov;5(4):224-33.
Salaçin S, Alper B, Cekin N, Gülmen MK. Bochdalek hernia in adulthood: a review and an autopsy case report. J Forensic Sci. 1994 Jul;39(4):1112-6.
Wenstrom KD, Weiner CP, Hanson JW. A five-year statewide experience with congenital diaphragmatic hernia. Am J Obstet Gynecol. 1991 Oct;165(4 Pt 1):838-42.
Langham MR Jr, Kays DW, Ledbetter DJ, Frentzen B, Sanford LL, Richards DS. Congenital diaphragmatic hernia. Epidemiology and outcome. Clin Perinatol. 1996 Dec;23(4):671-88.     
Donat SM, Donat PE. Intrathoracic kidney: a case report with a review of the world literature. J Urol. 1988 Jul;140(1):131-3.
Haller JA Jr. Professor Bochdalek and his hernia: then and now. Prog Pediatr Surg. 1986;20:252-5.
Quarless SA, Wells CN.  Bochdalek hernia, incidental finding on sestamibi parathyroid scan. Clin Nucl Med. 2005 Jun;30(6):436-9.